At a loss - Disappointed by Child psychiatric appointment.

Discussion in 'General Parenting' started by Arielle, Mar 17, 2008.

  1. Arielle

    Arielle New Member

    We took daughter to her first Child psychiatric appointment. yesterday. We were in the office for not more than 25 minutes total. First the Child Psychiatrist spoke to husband (husband said about 2 sentences about getting a tutor to free up time for myself and have less aggravation) and myself for about 15 minutes. Then she saw daughter for 5 minutes and then husband and I went in again with daughter for another 5 minutes.

    I told the doctor about daughter's history. I went into detail about her assessment in Nursery school (how her teacher was concerned about her behavior and not listening). The outcome of the assessment (social worker, PT therapist and Occupational Therapist (OT) therapist) was basically to give daughter PT for her gait and toe walking/shuffeling. I went on to tell the doctor about the MRI done at the neurologist when she was between 3-4 yrs. old and daughter's bad reaction to the chloral hydrate given to her to fall asleep on two occasions (she was given it twice because a blunder on the reception's part of not having the MRI approved through insurance the first time we went for the MRI.) (My husband refused to let them give daughter a sleep EEG because of her bad reaction to the chloral hydrate.) I also told the doctor about daughter's pediatrician referring daughter to a developmental pediatrician. I told her of daughter's increasing bad behavior, impulsiveness, violence against me and DS, and destruction of property. She had cracked Mom's windshield in her car because she was squirming around in the front seat and putting her feet up on the dashboard while we were waiting at a store for my brother to come out. She has also pinched holes in the moulding near the window on the door. My Mom has about 40-50 bubbles in the leather. daughter has also carved X's on the exterior paint. (This week, daughter pinched or made indentations/bubbles in the leather moulding of our new Lexus SUV.) daughter recently broke a panel of the vertical blinds in her room in 5 places. She recently cut her bangs up to her scalp. She drew hearts on her bedroom wall in purple permanent marker. daughter also has had encopresis on and off since its onset last September and that daughter has nocturnal enuresis. I mentioned the daily arguments and frustration of daughter not sitting down to do her homework as expected and that it generally takes 5 hours to complete one hour's worth of homework. These are only some of the things I told the doctor that I could think of at the top of my head. I also said daughter does not listen to a word that I say and that she herself says she enjoys getting on my nerves. I went on to explain that husband and I are not on the same page about discipline and that daughter is getting a mixed message. I also explained that I am at my wits end and do not know where else to turn and how to deal with daughter's behavior and that I am taking Ativan on occasion to calm my nerves and to help me cope.

    At first the doctor said that we should have daughter take some 3-hour test which was bascially an IQ test. Then she wanted to receive reports from the Neurologist and Developmental Pediatrician. She also wanted to speak to daughter's pychologist.

    The doctor then had daughter in for about 5 minutes. I do not know what they talked about. I was amazed when we were called in so soon after her going in. (by the way, daughter basically behaved well in the doctor's office. The doctor did find daughter a bit manipulative in bringing attention to herself and taking charge of the whole conversation while we were there.)

    She went on to say that she thought that the family as a unit should go into Family Therapy and that we needed to change the family dynamic. Well, duh, hello???????, that is what we have been doing since November!!!!!! Basically, we take daughter to the therapy appts. When daughter is unable to make the weekly appointment. with us because of some activity, one of us goes individually to speak to the therapist. husband and I have also been to the therapist together with-o daughter present. I proceeded to tell the doctor that husband does not discipline daughter for her behavior towards me and my mother. He does not scold daughter for destroying property. He says he will paint the wall, the car, replace the windshield and moulding for my mother, etc. I said that that was not sending the right message to daughter. By that type of response, he was letting daughter know that what she was doing was ok. The doctor did not want to speculate on what was right or wrong. She said that was not her job. She did not say she would test for ADHD or ODD and that she did not think she had ADHD. She said since daughter's school wasn't calling us up every day complaining about daughter and because daughter was an A and B student, she did not think daughter had ADHD. (In her 5 minutes of talking to daughter she found her to be smart as wsll as manipulative.) Well, I asked what about ODD? She said not to even go there yet.

    I asked about medication. She said there were medications, but she would be hesitant about giving daughter medication because of daughter's sensitive or bad reaction to the chloral hydrate medication given to her when she was younger to put her out for the MRI.

    The doctor left off saying that we did not need to make another appointment. with her. She made no further mention of having copies of reports sent to her or of having her tested for 3 hours.

    I feel totally unvalidated and at a loss. husband left the office grinning like the chesire cat because he felt like he won and daughter did not have to go on medications.

    Am I nuts or what? Can you assess in a half hour that daughter is not ADHD or ODD or some other mood disorder? Are my concerns not real or valid? I feel my daughter will not be helped and that her behavior will become worse. I won't be able to see the psychologist until after Easter vacation. I would like to tell her about how I was disappointed with the Child Psychiatrist appointment. We have an appointment. with the Pediatric Gastroenterologist tomorrow concerning the encopresis.

    I do not see how family therapy is going to help daughter if husband is not on board with the plan.
  2. Big Bad Kitty

    Big Bad Kitty lolcat

    AS far as a correct diagnosis, it is probably a good idea to have daughter seen by a neuropsychologist. They do very thorough and extensive evauations (I have heard up to 12 hours over the course of 2 or 3 days).

    Family therapy sounds like a good idea. husband will have his "discipline" (or lack of) brought to the table, and then an objective, outside party will be able to explain to him what is working and what is not. Likewise, what you are doing can be discussed, and with this non-biased person you can come to an agreement on how to rear your child in a way that you can both agree on.

    For now, let him think he won. Big deal. Maybe he will be more cooperative in therapy later!

    Sorry this is so hard for you. Big hugs.
  3. nvts

    nvts Active Member

    Arielle! Wait a minute! Why don't you call her office and see if they're ordering copies of her reports from the Dev. pediatrician. and neurological? She may have not made an appointment. because she doesn't know how quickly she'll get the reports and go over them. Don't throw in the towel!

    Also, I agree with BBK. A thorough neuropsychologist will give you more insight. Now before you start worrying, a neuropsychologist is a bunch of testing, but NOT a neurological test as far as EEG's and the stuff that made her sick when she was small. It's IQ's, and a ton of other tests that give them a direction to go as far as a diagnosis.

    Let us know how it goes!

  4. smallworld

    smallworld Moderator

    Arielle, what were you hoping to gain from seeing a child psychiatrist (psychiatrist)?

    In my experience, psychiatrists assess and treat mood issues (anxiety, depression, bipolar disorder, etc). Some (like the three psychiatrists my kids see) do psychotherapy. But psychiatrists do not assess for neurological issues like seizures or developmental disorders like Autism Spectrum Disorders (ASD).

    I believe the psychiatrist was right in not giving medication at this point because you really don't know what condition you're medicating for. The medications need to match the disorder.

    I think you have a couple of routes open to you at this point:
    1) A multidisciplinary evaluation
    2) A neuropsychologist
    Both can be found at children's or university teaching hospitals.

    You should also arrange an Occupational Therapist (OT) evaluation and a speech/language evaluation and finish up the neurological evaluation. by the way, a sleep-deprived EEG involves no medication. You basically keep the child up late and wake her up early so that when she goes for the test and is hooked up to the electrodes, she falls asleep on the table. You need to rule in or out as many medical and neurological issues as possible.

    What is the developmental pediatrician saying about what's going on? What is the therapist saying?
  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I think you need to take her to a neuropsychologist, not a Psychiatrist. That's where in my opinion you'll get the most thorough diagnosis and the best results. For us, that meant our son was tested for twelve hours in very specific ways and observed and talked to to see how well he can socialize, his eye contact, his understanding of language and anything eles. I don't think the doctor should have given her medicine yet. He doesn't know what is causing the behavior. It may NOT be ADHD/ODD. I would want her tested to everything, including autistic spectrum disorder, high functioning, before I gave this child medication. However, I disagree that family therapy alone is the key. This child may have a neurological condition that requires interventions, not a behavioral issue. Good luck!
  6. susiestar

    susiestar Roll With It

    Until you have some idea what is going on, this doctor problem will not be able to help. Hyper behavior can be caused by so many things.

    What you are doing with your daughter's therapist is NOT family counselling, nor is it couples counselling. The entire dynamic would be addressed in a systematic way in family therapy. The "I won, you lost" between you and husband would be addressed in couples therapy. I strongly urge you to seek out both.

    Get the neuropsychologist or multidisc. testing. It will help you greatly.

    The sleep-deprived EEG is crucial, in my opinion. Much of the behaviors could be seizures of some kind - you would be amazed at how many behaviors can be caused/altered by seizures.

    Go to the board FAQ forum. Do a Parent Report. Include pictures of the damage she has done to things, of every/any thing you can think of.

    Take VIDEO of your child's behavior. ESP when raging/tantrumming. It can be very helpful.

    But, until you and husband are on the same page, you are NOT going to get very far. His refusal to discipline her is telling her she is not doing anything wrong. It is a great disservice to her. Maybe if you let HIM deal with ALL the things she does - school calling, everything, then he will see. EVen let him pick up after her. Or get her to pick up.

    I am sorry it is so tough on you.

  7. 'Chelle

    'Chelle Active Member

    I would suggest as nvts mentioned, that you check with the psychiatrist's office and see if there was anything further that was recommended, like she was requesting reports. And and as everyone else mentioned, you need to look into further testing and 2nd opinions.

    When we went to our first appointment with our psychiatrist, who is also one of the leading developmental disorder people in our city, before the appointment date she had us fill out a several page report, got a report from his therapist that he'd been seeing about 8 months, got a report filled in by his teacher. Then at the appointment she talked with the whole family, then him alone, then us alone and this took about 90 minutes. We then had a 2nd appointment of about an hour. I don't think a 1/2 hour appointment is enough to diagnosis anything.

    While you're checking into getting further appointments with neuropsychologist, you might want to check out the FAQ/Board Help forum on doing a parent report. I find if have everything written down in advance, I don't have to try remember off the top of my head all the concerns I have. If I don't I always forget things that may be important and remember them later when we've already gone
  8. Arielle

    Arielle New Member

    Thanks for your replies everyone.

    The Child Psychiatrist did not ask for the names of daughter's other doctors nor request that any documents be sent to her after her initial indication of being interested in seeing reports. She made it clear that we did not need to see her for another appointment. and that we needed to go into Family Therapy. (We are seeing a psychologist as a family and individually when our daughter is unable to make the appts.)

    When I made the appointment. to see the Child Psychiatrist at the behest of the Psychologist, I was under the impression that the Child Psychiatrist would be the one to give an actual "official" diagnosis and then treat accordingly. I did not think that daughter would get medications after one appointment. with the Child Psychiatrist. I was hoping that the Child Psychiatrist could shed some light as to why daughter had the encopresis as well as garner some info and understanding of why daughter behaves the way she does. (I didn't get anywhere with this.) I just feel the whole appointment. was a total waste of time. She seemed to be contradictory in her statements. First wanting reports and then not. First discussing different medicines, and then saying she would be wary of giving daughter medicines because of her reaction to the chloral hydrate daughter had a bad reaction to when she had an MRI. First saying that she should have a 3-hour IQ test, and then after 5 minutes of talking to daughter rejecting that notion stating that daughter was smart and manipulative.

    I called daughter's psychologist to let her that I was disappointed with the appointment. with the Child Psychiatrist and she said she would consult with her further and get back to me.

    I just feel that I have not been on the right track and none of these professionals (Dev. Pediatrician, Psychologist and Child Psychiatrist) have been pointing me in the right direction of how to get my child officially diagnosed. I am going to mention if a neuropsychologist evaluation would be beneficial to daughter's psychologist and Dev. Pediatrician. I would be the happiest if it turns out that daughter only has a discipline problem due to husband's lack of discipline of daughter and that he is her enabler of the behavior towards me. To be truthful, I believe there is more to it and I want to find out to be certain.
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I can feel your frustration, trust me.
    The ONLY professional who bothered to test my son in detail and finally gave us answers that made a difference was my son's neuropsychologist. Not saying that this will work for you, but all the psychologists, psychiatrists and social workers, Occupational Therapist (OT) workers, PT workers, etc. didn't have a clue what was wrong with him. The neuropsychologist was right on the money and my son has gotten progressively better since his recommendations. They worked where ten plus medications only made things more complicated and dulled him cognitively.
  10. SRL

    SRL Active Member

    I'm sorry you've had such a run around. I hadn't read your earlier posts so I just went back and it sounds like you've been through a whole lot of assessments from an early age and still don't have any answers. There are red flags for something beyond ADHD/ODD going on here and if you're still seeing the developmental pediatrician s/he should have been doing more to help you. I do agree this psychiatrist shouldn't have offered medications without having a firm direction and it sounds like her practice might be functioning with having mostly outside diagnostics done and her taking it from there to do the medicating. That's fine if you understand that in advance and she provides direction to pull the diagnostics together, otherwise it would make for a frustrating appointment.

    I agree that a neuropsychologist is the way to go--lots of things going on here that probably have a common underlying explanation. Usually they aren't in such a rush and will really take time to listen.

    Does your daughter have friends? Is she asking to have kids over and being invited over to play in return? What are her teachers reporting about her social skills--is she playing with kids, playing alongside them, etc?
  11. TerryJ2

    TerryJ2 Well-Known Member

    I agree that the dr did not have enough info to do a complete evaluation. Call the ofc to see if they have ordered copies of the reports. Then call back in a wk to give the dr time to look at them.
    You're going to have to do family therapy no matter what, because a special child does change the dynamics, so I would accept that advice and blow it off at the same time.
    I would also be very specific about what sorts of results you're looking for in medications, such as anger management and impulse control. Use those words instead of "kicking in the windshield." It sounds like this doctor is into clinical stuff. You can only try.
    I know the feeling of disappointment. So sorry.
    Oh, by the way, most psychiatric appts are 45-50 min. so don't expect a full hr unless you reserve it ahead of time and agree to pay extra.
  12. tammyjh

    tammyjh New Member

    I ditto the neuropsychologist. We've had difficult child to two different neuropsychs and they were both really good. The first one when she was 9 for about 6 hours of testing. The second when she was 13 for about 8 hours of testing. It was very thorough and gave a good explanation of a lot of difficult child's strengths and weaknesses.

    We've not had very good luck with psychiatrists and we've seen quite a few to date. We've also not had the best luck with neurologists to date...but still holding out hope that there may be "one" who is actually interested.

    Wishing you lots of luck in your quest for help for your daughter.
  13. totoro

    totoro Mom? What's a GFG?

    So sorry... but I would take each apt as a learning experience. Try not to hold onto the negative experiences. otherwise it will eat you and your family up. Don't look at it as what the Doctors were supposed to do, but what can you take from each apt.?
    I know it is hard and you feel desperate at times... believe me I am on my 5th psychiatrist with K... we have flown all over for these apts. and now we are moving!!!
    It s-uck-s
    But you have to always try to remain consistent throughout it all for your children. Try to remain calm and positive... you are the force in your home. You are the role model, for you, husband and the children.
    You are not being asked to be perfect... but I have found that none of these Doctors are really going to be there for ME and my family through it all... so it really is just me and my family. THEY need to be strong.
    And when you find a great pediatrician, or therapist, or psychiatrist. gleen what you can from them... and treat them kind also.
    Don't rush this... I know your road has been long already, but it will come. Hang in there. Give yourself and your family a break on the days it is too much.